While telemedicine is hardly a new concept, it is only in very recent times that it has started to show its true promise. What started as a simple service where patients could contact the doctors using the telephone or the Internet has burgeoned into a new industry covering mental health, lactation consulting, nutrition and general acute medicine.
The roots of modern internet-based telemedicine date back to 2002 and a young company called Teladoc that provided medical services using video and audio over the Internet. Over the past 13 years Teladoc has provided their patients with over 289,000 consultations with medical professionals and claims a 95% satisfaction rating. Now they are seeking to parlay that success into an initial public offering.
It may be surprising that it has taken so long for patients to really start thinking about telemedicine. As costs mount within the healthcare system everybody is looking for efficiencies, but often for different reasons.
Payers have embraced telemedicine because it reduces cost. Anthem Blue Cross Blue Shield’s “livehealth” service focuses on acute conditions such as colds, flu, sinus infections, bronchitis, pink eye and ear infections. The patient is charged $49 if they have not met the deductible, or some portion of that based on co-pays and coinsurance. Typical appointment times run approximately 10 minutes and represent a considerable saving over a bricks and mortar visit.
Many telemedicine services are actively advertising for contract providers who are seeking to boost declining reimbursement. Appointments can be scheduled at convenient times during the day, perhaps even when patients failed to show up for their appointments. Doctors can set their own schedule and enjoy the lifestyle benefits.
For the patient there are two primary drivers.
The typical user of telemedicine services is a woman aged between 35 and 45 – a demographic in which convenience is of the upmost importance. It’s hard to find time to go to the doctor when you are managing an active worklife and children. Inconvenient office hours and long waits conspire to wreak havoc upon the family schedule and walking into your bedroom and talking to the doctor on your iPhone is a dream come true.
As healthcare plans have become increasingly more expensive patients are looking for new ways to reduce their costs. Most telemedicine services targeted in the $49 range, a figure that is deliberately designed to be under the cost of many patients co-pays. When combined with health saving and flexible spending accounts this price is even more attractive, especially to patients who are part of high deductible plans and have not yet reached the deductible.
While using your iPhone may be convenient, pharmacies such as CVS, Walgreens, and Rite Aid have moved in the direction of private kiosks equipped with medical measurement and videoconferencing capabilities. This offers the convenience of seeing a doctor and walking over to the pharmacy desk to pick up your prescription just a few minutes later. It’s a compelling idea for pharmacies that need to remain relevant in the price driven world of modern healthcare by extending their reach and providing additional services.
Using a pharmacy offers the ability to use medical devices that are not generally available to patients using their computer or smart phone. Blood pressure cuffs at pharmacies have been de rigueur for many years. When combined with an otoscope, digital stethoscope, and s10:491pirometry, many common conditions can be more effectively diagnosed than at home.
Some question if patients are receiving the same care when using telehealth. At this point nobody is really sure, but the signs are good.
A recent study around prescriptions issued from virtual encounters showed that the rate of prescription is statistically equivalent to that of a brick and mortar visit. On the negative side, the agents prescribed tended to be broader spectrum leading some to suggest that physicians are “covering their bases” by using bigger guns than are truly needed.
The likelyhood of harm to a patient is greatly reduced by the set of conditions that a telehealth provider will treat. It’s reasonable to assume that most physicians who are presented with a complex case over a video feed will probably direct the patient to the nearest acute care center or emergency department. As such, the only potential damage in using telehealth is to the patient’s pocket if a secondary visit is required, and even then the costs are minimal.
As this week progresses, I’ll be working through other aspects of Telehealth in more detail. It’s a fascinating trend in healthcare that offers the prospect of convenience and price savings for simple conditions in the medical, psychological and nutrional spaces.